A study of the programme, carried out by the National Institutes of Health Research (NIHR) and released this month, found there was a highly significant 88 per cent reduction in the incidence of diabetes in people who completed the course, including follow-up refresher sessions.

It comes following figures unveiled at the Diabetes UK conference in March suggesting that by the end of January, GPs had referred 25,687 people who were deemed at-risk of developing the condition, against a target of 24,605. However, it is thought only 7,232 of 20,000 places have been filled.

There isn’t much happening in terms of engagement and getting people through, and this is an area of intense research – how can we keep people going on the programme

Speaking to the publication Pulse about the new research, co-investigator Professor Kamlesh Khunti, professor of primary care at the University of Leicester and a member of the steering committee of the NHS Diabetes Prevention Programme, said: “The lesson here for the national programme is, we haven’t thought through how we retain people who attend the programme.

“There isn’t much happening in terms of engagement and getting people through, and this is an area of intense research – how can we keep people going on the programme? A lot of this is keeping them engaged through regular feedback, regular texting that sort of thing.

“We may need to tailor our programmes – for example, not everyone wants to come to face-to-face sessions, but once they have been to one face-to-face meeting, maybe they can get online programmes.”

NHS England is already looking at adapting the programme to suit more people. It is testing an online approach – under the tag ‘digital DPP’ – in 11 areas, which will be offered to people who previously declined to attend an initial consultation.

The national scheme is in the process of rollout to a further 20 sites across England, but it has emerged that one – Gloucestershire – has yet to find a provider for the lifestyle programme.

NHS England said in a bulletin that ‘the contract for Gloucestershire will be re-tendered once the outcome for other Year 2 sites is known – allowing the possibility of the establishment of economies of scale by providers – following the receipt of no bids’.

Professor Jonathan Valabhji, NHS England national clinical director for diabetes and obesity , said: “The Healthier You NHS Diabetes Prevention Programme is based on the best evidence from RCTs and pragmatic trials carried out in real-world settings, and our intervention is significantly more intense than that delivered in the Leicester trial.

“What the Leicester trial did show is the importance of duration of patient participation, which is precisely why providers of our new Healthier You programme are paid on that basis.”